Abstract

OBJECTIVE:We present the initial results of single and concomitant aortic, mitral or
even multiple valve surgery through the
upper or lower mini-sternotomy.

METHODS:From September
2017 to December 2017, 14 patients
with isolated aortic, mitral and combined valve disease underwent valve
replacement or repair by means of upper (10 cases) or lower (4 cases) ministernotomy.
Multi-spiral contrast-enhanced CT scan was done to enroll patients for upper or
lower incision. A six centimeter skin incision and partial sternotomy with
extension to the third right intercostal space was performed. Central
cannulation of both aorta and vena cava was utilized in all cases, depended on
the type of sternotomy. Arresting of the heart was provided by a single dose of
antegrade crystalloid (12 cases) or cold blood cardioplegia (2 cases).

RESULTS:The access to
the aortic and mitral valves was standard in cases of lower mini-sternotomy.
The access to the mitral valve in case of upper ministernotomy was achieved
through the left atrium roof. A LV vent was inserted directly into the aortic
root. Removing of valves, placing the stitches and prosthesis insertion was
standard without any device. The aortotomy and atriotomy were closed in two
layers and the chest closed in a standard fashion. There were 4 cases of
isolated aortic valve replacement, 1 case of mitral and tricuspid valve repair,
1 case – mitral valve replacement, 8 cases of double valve replacement. The postoperative
course was uneventful in all cases.

CONCLUSION:According to
our initial results, both single and multiple valve surgery can be safely
performed via a upper or lower mini-sternotomy. Preoperative CT scan is a very
useful and essential option for surgical strategy. Sufficient exposure without femoral
cannulation and any special devices can be achieved with upper or lower
mini-sternotomy.

26TH ANNUAL MEETING OF THE ASIAN SOCIETY FOR CARDIOVASCULAR AND THORACIC SURGERY